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Dr. K P Kushwaha Prof & Head,  BRD Medical College, Gorakhpur Nutrition and the  0-6 Months Infants
Evidence classification  ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Infant feeding Recommendations (Global strategies for Infant & Young Child Feeding)  ,[object Object],[object Object],[object Object],[object Object],[object Object],Slide
Infant feeding Recommendations (Global strategies for Infant & Young Child Feeding)  ,[object Object],[object Object],Slide
HIV :2000 and 2006 WHO Recommendations ,[object Object],[object Object],[object Object],[object Object],Slide
IYCF Practices-India  ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],Source: NHFS-3 Slide  ( Squeezing and discarding of colostrum and prelacteal feeds are quite common)
Trends in Nutritional Status Percent of children age under 3 years (Low-height-for-age) (Low-weight-for-height) (Low-weight-for- age) Slide  Source: NHFS-2 & 3
Anaemia among Children Percent of children 6-35 months with anaemia Slide
How Many Children Receive Services from an AWC?  ICDS (??? 0 – 6 yrs ) Percent of age-eligible children in areas with an AWC Slide  How many 0-6 ms are being looked after? Source: NHFS-3
Benefits   to Baby (evidence class I –III) ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],Slide
Why Breast milk for preterm  ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],Slide  Evidence class I
Lancet 2004;363:1571-8 Singhal A, Cole TJ, Lucas A Breastmilk and Lipoprotein profile in adolescents born preterm: Followup of a prospective randomised study (n=926) Slide  Evidence class I
Breast milk composition differences (dynamic) ,[object Object],[object Object],[object Object],Slide  Evidence class I
Slide
Slide
Colostrum ( evidence class I-III ) ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],Slide
Slide
More Benefits to Baby (When they grow) ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],Slide  Evidence class II -III
Benefices for Mom ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],Slide  Evidence class II -III
Community  Benefits   New parents miss Less work Fewer healthcare Visits & lower  Treatment costs Breast milk is a Natural and Renewable resource Slide  Evidence class III
Breastfeeding prevents under nutrition and obesity ,[object Object],[object Object],[object Object]
Breastfeeding decreases the prevalence  of obesity in childhood at age five and six years, Germany Adapted from:  von Kries R, Koletzko B, Sauerwald T et al. Breast feeding and obesity: cross sectional study.  BMJ,  1999,   319:147-150. Slide
Higher Intelligence quotient ( Evidence class I-II) BF = breastfed FF = formula fed BM = breast milk Slide  BF 2.1 points higher than FF Study in 6 months to 2 year- olds 1988 BF 8.3 points higher than FF Study in 7.5-8 year-olds 1992 BF 2 points higher than FF Study in 3-7 year-olds 1982 BM 7.5 points higher than no BM Study in 7.5-8 year-olds 1992 BF 12.9 points higher than FF Study in 9.5 year-olds 1996 References: ,[object Object],SciMed 1982 ,[object Object],SocSciMed 1988 ,[object Object],[object Object]
Potential Child Mortality Reduction  from Preventive Interventions  Jones et al.  How many deaths can we prevent this year?  Lancet 2003 Slide  Preventive Intervention Number  (thousands) Deaths prevented  as proportion of  all child deaths  Breastfeeding 1301 13% Insecticide - treated materials 691 7% Complementary feeding 587 6% Zinc 459 5% H influenzae vaccine 403 4% Antiseptic delivery 411 4% Water, sanitation, hygiene 326 3%
The value of breast milk  to the national economy in India ,[object Object],[object Object],[object Object],[object Object],Adapted from: Gupta and Khanna.  Economic value of breastfeeding in India.  The National Medical Journal of India,  1999, May-June 12(3):123-7. Slide
Comparative health care costs of treating breastfed and formula-fed babies in the first year of life in a health maintenance organization (HMO) ,[object Object],[object Object],[object Object],[object Object],Adapted from: Ball & Wright.  Health care costs of formula-feeding in the first year of life.  Pediatrics,  1999,   April, 103(4 Pt 2):870-6. Slide
In addition, the 1000 never-breastfed infants had: ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],Adapted from: Ball & Wright.  Health care costs of formula-feeding in the first year of life.  Pediatrics,  1999,   April, 103(4 Pt 2):870-6. Slide
Slide
What is the infant mortality risk  from not breastfeeding? WHO Collaborative Study Team on the Role of Breastfeeding on the Prevention of Infant Mortality. Effect of breastfeeding on infant and child mortality due to infectious diseases in less developed countries: a pooled analysis. Lancet. 2000 Feb 5;355(9202):451-5.   Pooled Odds Ratios Lowest tercile of mat. education Ghana Slide
The baby Killer  ,[object Object],[object Object],(Andy Chetley/war on want, 1974) Slide
Mother of Twin  Slide  Mother of twins - mother in law told her she didn’t have enough for two, UNICEF 1992, Mushtaq Khan
Artificial jewelry  Animal Milk  Real Gold jewelry  Breast milk  Slide
How do we are compare  Cow with calf Mother Breastfeeding Slide
Why Mothers do not succeed?  Slide  Evidence class I-III NO? No  Correct information   Lack of Early Assistance   Embarrassed   Hospital practice   Work or school Fear Tied down ‘ modern’ way Marketing of formula No  role  Models   No confidence No  support
Manufacturing Malnutrition  ,[object Object],Promoting best food for baby   And where is miracle   ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],Sales Who  its  production ,[object Object],[object Object],Slide
Marketing Confuses Mothers   ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],Confused mother Baby’s Misery Slide
Which photograph will increase TRP ? ( Even Media is afraid of Promoting   Breastfeeding )   Which photograph will create controversy ?  Malnourished baby & mother  A beautiful women breastfeeding  Slide
Milk Donations (What NGOs do for 0-6m nutrition?) Slide
Role of International Health Agencies Pressure  groups  IBFAN   International Assembly  of Infant food  manufactories  ,[object Object],[object Object],[object Object],Slide
What is Advice ,[object Object],[object Object],[object Object],[object Object],[object Object],Slide
What is promotion?  Slide
Slide
What is support? ,[object Object],[object Object],[object Object],[object Object],Slide
Two Most Common Complaints  ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],Slide
When a mother thinks… ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],Slide
Two Most Common Complaints ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],Slide
Slide
Slide
Two Most Common Complaints ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],Slide
Effective  Communication  Explore  Feelings  Information, Options, Suggestions  Respect Identify & Praise right things Accept what she ‘ thinks’ or  feels Listen carefully  Ask open  ended questions  Provide  Practical  Help Slide  Evidence class I-II
New 2006 WHO Guidance   ( HIV and 0-6 Months) ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],Slide
[object Object],[object Object],Slide
[object Object],[object Object],[object Object],Slide

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Nutrition And The 0 6 Months Infants (Final)

  • 1. Dr. K P Kushwaha Prof & Head, BRD Medical College, Gorakhpur Nutrition and the 0-6 Months Infants
  • 2.
  • 3.
  • 4.
  • 5.
  • 6.
  • 7. Trends in Nutritional Status Percent of children age under 3 years (Low-height-for-age) (Low-weight-for-height) (Low-weight-for- age) Slide Source: NHFS-2 & 3
  • 8. Anaemia among Children Percent of children 6-35 months with anaemia Slide
  • 9. How Many Children Receive Services from an AWC? ICDS (??? 0 – 6 yrs ) Percent of age-eligible children in areas with an AWC Slide How many 0-6 ms are being looked after? Source: NHFS-3
  • 10.
  • 11.
  • 12. Lancet 2004;363:1571-8 Singhal A, Cole TJ, Lucas A Breastmilk and Lipoprotein profile in adolescents born preterm: Followup of a prospective randomised study (n=926) Slide Evidence class I
  • 13.
  • 14. Slide
  • 15. Slide
  • 16.
  • 17. Slide
  • 18.
  • 19.
  • 20. Community Benefits New parents miss Less work Fewer healthcare Visits & lower Treatment costs Breast milk is a Natural and Renewable resource Slide Evidence class III
  • 21.
  • 22. Breastfeeding decreases the prevalence of obesity in childhood at age five and six years, Germany Adapted from: von Kries R, Koletzko B, Sauerwald T et al. Breast feeding and obesity: cross sectional study. BMJ, 1999, 319:147-150. Slide
  • 23.
  • 24. Potential Child Mortality Reduction from Preventive Interventions Jones et al. How many deaths can we prevent this year? Lancet 2003 Slide Preventive Intervention Number (thousands) Deaths prevented as proportion of all child deaths Breastfeeding 1301 13% Insecticide - treated materials 691 7% Complementary feeding 587 6% Zinc 459 5% H influenzae vaccine 403 4% Antiseptic delivery 411 4% Water, sanitation, hygiene 326 3%
  • 25.
  • 26.
  • 27.
  • 28. Slide
  • 29. What is the infant mortality risk from not breastfeeding? WHO Collaborative Study Team on the Role of Breastfeeding on the Prevention of Infant Mortality. Effect of breastfeeding on infant and child mortality due to infectious diseases in less developed countries: a pooled analysis. Lancet. 2000 Feb 5;355(9202):451-5. Pooled Odds Ratios Lowest tercile of mat. education Ghana Slide
  • 30.
  • 31. Mother of Twin Slide Mother of twins - mother in law told her she didn’t have enough for two, UNICEF 1992, Mushtaq Khan
  • 32. Artificial jewelry Animal Milk Real Gold jewelry Breast milk Slide
  • 33. How do we are compare Cow with calf Mother Breastfeeding Slide
  • 34. Why Mothers do not succeed? Slide Evidence class I-III NO? No Correct information Lack of Early Assistance Embarrassed Hospital practice Work or school Fear Tied down ‘ modern’ way Marketing of formula No role Models No confidence No support
  • 35.
  • 36.
  • 37. Which photograph will increase TRP ? ( Even Media is afraid of Promoting Breastfeeding ) Which photograph will create controversy ? Malnourished baby & mother A beautiful women breastfeeding Slide
  • 38. Milk Donations (What NGOs do for 0-6m nutrition?) Slide
  • 39.
  • 40.
  • 42. Slide
  • 43.
  • 44.
  • 45.
  • 46.
  • 47. Slide
  • 48. Slide
  • 49.
  • 50. Effective Communication Explore Feelings Information, Options, Suggestions Respect Identify & Praise right things Accept what she ‘ thinks’ or feels Listen carefully Ask open ended questions Provide Practical Help Slide Evidence class I-II
  • 51.
  • 52.
  • 53.

Editor's Notes

  1. Source: Table 4.10
  2. The United Nations Millennium Declaration, was adopted on 8 September 2000 by all 189 Member States of the United Nations (147 of them represented directly by their head of State or Government). This Declaration embodies a large number of specific commitments aimed at improving the lot of humanity in the new century. The Declaration is divided into eight sections as listed in the slide. Sections 3 and 4 are highlighted since these are the only sections within the Declaration from which the Millennium Development goals have grown.
  3. A vast scientific literature exists demonstrating the health, psychosocial, and economic benefits associated with breastfeeding & different BF patterns. A 2000 meta-analysis of over 500 infant deaths in environments where diarrhea and respiratory infections are the major causes of infant mortality ( Brazil, Pakistan, the Philippines – …data from the Gambia, Ghana and Senegal after 11 mo because virtually all babies were BF in first year ) found that non-breastfed babies were significantly more likely to die of infectious diseases than breastfed infants (WHO, 2000). The benefits of breastfeeding were greatest in the first two months of life (OR 5.8) and declined with age (up to the first year, at which time it did not continue to show continued declines - hovered around 2 (12-15 mo  1.6, 16-19 mo  2.1, 12-23 mo   1.7) . The Risk of death from not BF in settings with HIV may be higher than these WHO, 2000 overall figures because: - differential risks in WHO 2000 by education of mother at 6-11 mo: OR = 5.1, lowest tercile (least education, authors’ rec for HIV) (vs 2.0 medium tercile or 1.1 highest tercile) r ather than pooled OR of 1.8 (6-8 mo) or 1.4 (9-11) - Non – BF infants 12-24 mo of age in Ghana had 7.9 times higher risk of death than BF infants. Two more studies since this meta-analysis have also confirmed higher rates associated with not-BF - Bahl et al* found the ROR was 10.5 from 6 wk to 6 mo in Ghana, India and Peru - Rutstein**(DHS) estimated ROR was about 3 ( 2.7) for 6-12 months *Bahl R, et al. Infant feeding patterns and risks of death and hospitalization in the first half of infancy: multicentre cohort study. Bull World Health Organ. 2005 Jun;83(6):418-26. **Rutstein SO Effects of preceding birth intervals on neonatal, infant and under-five years mortality and nutritional status in developing countries: evidence from the DHS. Int J Gynaecol Obstet. 2005 Apr, 89 Suppl 1:S7-24.